Parenting Behavior Plays a Part in Preschoolers' Sleep Problems

Action Points

Explain to interested patients that this study found that early sleep problems and parental behaviors combined to predict sleep disturbances in children through age six.

MONTREAL, April 8 -- Sleep problems in preschoolers may be partly the result of disturbances earlier in childhood and how parents respond to them, a longitudinal study revealed.

In a study of nearly 1,000 children, sleep disturbances at ages five to 17 months predicted parental behaviors such as the mother being present when the child fell asleep, taking the child out of bed at night, which includes moving the child into the parents' bed (co-sleeping), and giving food or drinks at night, found Valerie Simard, M.Sc., M.Ps., of the University of Montreal, and colleagues.

However, these parental behaviors only explained some of the sleep problems seen through age six years after controlling for earlier sleep disturbances, the investigators reported in the April issue of Archives of Pediatrics & Adolescent Medicine.

"Our findings clarify the long-debated relationship between parental behaviors and childhood sleep disturbances," they said. "They suggest that co-sleeping and other uncommon parental behaviors have negative consequences for future sleep and are thus maladaptive."

Few studies have examined the interaction between parents' behaviors and their children's sleep problems, except for co-sleeping, according to the researchers.

Still, the effect of co-sleeping on a child's health, sleep, and psychological development remains unclear, they said.

To explore the interaction of parental behaviors and sleep problems in children further, the researchers turned to the Quebec Longitudinal Study of Child Development, which annually surveyed children born in the province of Quebec in 1997 and 1998. They were followed from ages five months through six years.

Parents, usually the mother, completed questionnaires on their children's sleep, temperament, and anxiety level and their own psychological characteristics and parenting behavior.

Early sleep problems from ages five to 17 months predicted parental behaviors when the child was age 41 months.

For example, a child who was not sleeping through the night at age 17 months was more likely to have a mother who was present when the child was falling asleep (OR 3.06, 95% CI 1.94 to 4.84, P<0.01), a parent who took the child out of bed after awakening at night (OR 1.85, 95% CI 1.10 to 3.14, P<0.05), and a parent who would give the child food or drinks to help them sleep (OR 4.53, 95% CI 2.06 to 9.97).

These parental behaviors, in turn, predicted some sleep problems, including bad dreams, a total sleep time of 10 hours or less, and a sleep onset latency of 15 minutes or more, in their children through age six.

For example, co-sleeping predicted a greater risk of a child having a sleep onset latency of 15 minutes or more at ages 50 months (OR 1.94, 95% CI 1.14 to 3.29, P<0.05) and five years (OR 1.81, 95% CI 1.08 to 3.04, P<0.05).

Parental behaviors, however, became less predictive than early sleep problems after controlling for earlier sleep disturbances and socioeconomic factors.

A sleep-onset latency of 30 minutes or more at age 50 months predicted a total sleep time of 10 hours a night or less at age 50 months (OR 3.69, 95% CI 2.17 to 6.29, P<0.01), five years (OR 1.99, 95% CI 1.14 to 3.47, P<0.05), and six years (OR 2.18, 95% CI 1.18 to 4.00, P<0.05).

The study was limited, the authors said, by the high dropout rate. Also, the questionnaires were not validated and reflected parents' perceptions of their children.

Nevertheless, "our results permit an interpretation that goes beyond the view of parental behaviors as reactive," the researchers said. "They also suggest that early sleep problems are more predictive of future sleep disturbances than are intervening parental behaviors."

In an accompanying editorial, Michelle Cao, D.O., and Christian Guilleminault, M.D., Biol.D., of Stanford, wrote that, in some cultures, children sleeping with parents, grandparents, or siblings is normal and not unconventional as Simard and colleagues contended.

"Results from this study, though interesting, need to be moderated," they concluded. "It would be more prudent to take into account cultural differences regarding sleep habits combined with a high suspicion for the presence of a sleep disorder in evaluating a child with a suspected sleep disturbance."

The study was supported by the Ministry of Health and Social Services, the Canadian Institutes of Health Research, the Social Sciences and Humanities Research Council of Canada, the J.A. De SÃ¨ve Foundation, the Quebec Fund for Research on Society and Culture, the Quebec Fund for Research on Nature and Technology, the Health Research Fund of Quebec, the Molson Foundation, the Ministry of Research, Science, and Technology, Human Resources Development Canada, the Canadian Institute for Advanced Research, Health Canada, the National Science Foundation, the University of Montreal, Laval University, and McGill University.

The authors and the editorial writers reported no financial disclosures.

Reviewed by Robert Jasmer, MD Associate Clinical Professor of Medicine, University of California, San Francisco